Today the federal Centers for Medicare and Medicaid Services (CMS) announced its decision to reject the state’s proposed Healthy Ohio Medicaid waiver. CMS expressed concern with the proposed waiver’s plan to charge premiums to enrollees, regardless of income, and to exclude from coverage anyone who missed a payment, ultimately harming access to affordable coverage.

In an open letter, the following organizations urged Ohio insurers, who enroll InHealth members, to apply the medical expenses incurred under the InHealth plan toward the new deductible and out of pocket maximum;

On May 10, 2016, the Ohio Department of Insurance (ODI) signed off on the merger of Aetna and Humana insurance companies without a hearing. Despite the magnitude of this decision, ODI only issued a 1 ½ page decision paper, that they buried deep on their website.

“The Ohio Department of Insurance was secretive about the merger; Ohio residents deserve transparency on a decision that will affect so many of their lives,” said Steve Wagner, Executive Director of UHCAN Ohio, one of seven consumer organizations that on February 10, 2016 submitted a letter requesting a hearing on this merger.

“The consumers’ letter raised at least six substantive issues and the brief decision addressed none of them,” added Wagner. “First and most important is that the merger will give the combined Aetna-Humana entity a 50 percent market share in Medicare Advantage throughout Ohio. This concentration would be made worse with Anthem (party to a separate merger request) also controlling 23 percent of the market.[1] Market concentration falls squarely within the statute that establishes the criteria for review (3901.321 (F)(1)(a) – (f), and also requires that the findings be made after holding a hearing.” However, ODI failed to consider market concentration. In fact, ODI said “There are no facts before the Superintendent to support a determination” [that the effect of the merger would substantially lessen competition in insurance in this state or tend to create a monopoly (3901.321 (F)(1)(b)]. Since ODI has information on market concentration and can query insurers, it begs the question of how much effort was put into the investigation necessary to protect people’s health care.